City of Victoria Form Center

2. Thank you for your interest in our 2024 Victoria Fire Academy!

   Please fill out the below information.

4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
15. Email Address*
17. Voluntary Demographic Data
    THIS INFORMATION IS STRICTLY VOLUNTARY. The information given is used for statistical reporting to various regulatory agencies. This information will in no way be used in consideration of your application.
19. Gender:
21. Hispanic/ Latino

    1. Yes
    2. No
23. Racial Designation:
25. Education
27. Did you graduate high school? *

    1. Yes
    2. No
29. List High School name(s): *
31. High School Address: *
33. City*
34. State*
35. Zip Code
37. Did you receive your High School Diploma or GED? *

    1. Yes
    2. No
39. Supplemental Questions
41. Are you 18 or older? *

    1. Yes
    2. No
43. Do you possess a TDSHS EMT Certification? *

    1. Yes
    2. No
45. If not, are you currently enrolled?
47. Certification
49. This is a government document. Submission of false information on a government document is a crime. I certify that all the information provided by me in connection with my academy application, whether on the document or not, is true and complete, and I understand that any misstatement, falsification, or omission of information shall be grounds for refusal to admit or if admitted, discharge from the academy. The City of Victoria does not discriminate on the basis of race, religion, color, age, gender, sexual orientation, national origin, disability or military status. I certify that I have read and agree with these statements. *
51. Name: *
    Full Name
53. Date: *
    Date:
55. Please upload copies of the following documents with the application:
57. Texas DSHS EMS Certification
59. High School Diploma or G.E.D.
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field